Adriamycin in the treatment of childhood acute leukemia. A Southwest Oncology Group study

Controllability of Graphene Oxide Doxorubicin Loading Capacity Based on Density Functional Theory

Graphene can be used as a drug carrier of doxorubicin (DOX) to reduce the side effects of doxorubicin. However, there is limited research on the surface chemical modifications and biological effects of graphene oxide (GO). Therefore, it is necessary to explore the DOX affinity of different oxygen-containing functional groups in the graphene system. We constructed graphene system models and studied the structure and distribution of epoxy and hydroxyl groups on the carbon surface. Based on molecular dynamics simulations and density functional theory (DFT), we investigated the interaction between DOX and either pristine graphene or GO with different ratios of oxygen-containing groups. The hydroxyl groups exhibited a stronger affinity for DOX than the epoxy groups. Therefore, the DOX loading capacity of graphene systems can be adjusted by increasing the ratio of hydroxyl to epoxy groups on the carbon surface.

Bibliometric Analysis of the Results of Cardio-Oncology Research

Objective

To analyze the development of cardio-oncology, summarize the research achievements, and provide proposals for its future research.

Methods

The web of science database was used to search for “cardio-oncology” and “oncocardiology” related articles from the beginning of the database (1970) to April 5, 2019. Excel 2016 and Cytoscape were used to analyze the trend of cardio-oncology research.

Results

A total of 356 articles were obtained. The number of articles has grown rapidly in recent years. Cardiac injury caused by tumor therapy was a research hotspot (n = 107). Researchers paid more attention to the prevention and treatment of cardiotoxicity (n = 54). Experimental researches were a small part of all studies (n = 72), mainly focusing on the study of cancer drugs' cardiac injury, test indicators of cardiotoxicity, and preventive drugs. The United States (n = 156.25), Italy (n = 48.5), and Canada (n = 23.5) published the most articles, making a great contribution to the development of cardio-oncology.

Conclusions

Cardio-oncology has been developing rapidly and receiving a large amount of research efforts in recent years. Most articles on cardio-oncology were published by the authors from the United States (44%) and Italy (17%), while other countries need to pay more attention to cardio-oncology. As an independent discipline, cardio-oncology is certainly in need of significant progress, but it has formed a basic framework, which has obtained many leading theories and meaningful achievements in diagnostic criteria, diagnostic methods, prevention and treatment, mechanism research, and influencing factor. Cardiac injury of tumor drugs has always been a research hotspot in this discipline, and there is still a lot of research space. The research about detection methods of cardiotoxicity and preventive drugs is gradually increasing. Basic research lags behind, and many mechanisms are still unclear.

Apigenin Attenuates Adriamycin-Induced Cardiomyocyte Apoptosis via the PI3K/AKT/mTOR Pathway

Treatment with Adriamycin (ADR) is one of the major causes of chemotherapy-induced cardiotoxicity and therefore is the principal limiting factor in the effectiveness of chemotherapy for cancer patients. Apigenin (API) has been shown to play a cardioprotective role. The present study examined the effect of API on ADR-induced cardiotoxicity in mice. Sixty male Kunming mice were randomly divided into 4 groups: a control group, ADR model group, low-dose API treatment group (125 mg·kg⁻¹), and high-dose API treatment group (250 mg·kg⁻¹). Blood samples were taken to evaluate a spectrum of myocardial enzymes. Cardiomyocyte apoptosis was measured using a TUNEL assay, and cardiomyocyte autophagy was observed using electron microscopy. Moreover, apoptosis-related proteins, such as Bax and Bcl-2, autophagy-related proteins, including Beclin1 and LC3B, and PI3K/AKT/mTOR pathway-related proteins were examined with western blot. Our results demonstrate that ADR caused an increase in the serum levels of cardiac injury markers and enhanced cardiomyocyte apoptosis and autophagy. API administration prevented the effects associated with ADR-induced cardiotoxicity in mice and inhibited ADR-induced apoptosis and autophagy. API also promoted PI3K/AKT/mTOR pathway activity in ADR-treated mice. In conclusion, API may have a protective effect against ADR-induced cardiotoxicity by inhibiting apoptosis and autophagy via activation of the PI3K/AKT/mTOR pathway.

Prolonged remission in Di Guglielmo's syndrome

A case is reported of a 12-year-old boy with Di Guglielmo's syndrome who achieved complete remission for over three years before developing a central nervous system relapse. The poor results of treatment in this disease are reviewed and the arguments for routine central nervous system prophylaxis discussed.

Erythroleukemia: a study of 15 cases and literature review

Out of a total of 185 cases of acute leukemia at our institution from 1967 to 1978, fifteen cases (8.1%) were identified as erythroleukemia or erythremic myelosis. The symptoms at presentation were often related to anemia (10/15 cases); the presenting hemoglobin value was lower than 10.0 gm/100 ml. Nucleated red cells were present in the peripheral blood and reticulocyte response was inappropriate to the degree of anemia. Marrow biopsy showed erythroid hyperplasia with megaloblastic and dyserythropoietic features, increase in myeloblasts greater than 5% (10/15 cases), positive PAS staining of erythroid precursors (12/12 cases), and erythrophagocytosis by abnormal erythroid precursors (6/15 cases). Abnormalities were noted in monocytic and megakaryocytic cell lines, and it was concluded that erythroleukemia is probably a stem cell disorder. Response to chemotherapy was poor with median survival of four months from initial diagnosis. Intracranial hemorrhage and bacterial or fungal infection were the most frequent cause of death.

Intermittent combined chemotherapy with doxorubicin in recurrent childhood acute lymphoblastic leukemia

A series of 14 children with bone marrow or testicular recurrence of acute lymphoblastic leukemia (ALL) and treated with pulsed combined chemotherapy incorporating doxorubicin is reviewed. All had been previously adequately treated according to established leukemia protocols. Median disease-free survival for the series is 46 weeks, overall survival 62 weeks, and the toxicity of the therapy relatively low. This compares favorably with other reports of treatment of relapsed ALL and supports the formulation of prospective trials to evaluate anthracyclines in initial induction and consolidation phases of treatment of childhood ALL.

Low-dose adriamycin remission maintenance for advanced acute lymphoblastic leukemia: a Southwest Oncology, Group study

A low-dose maintenance schedule of adriamycin was evaluated in children with advanced acute lymphoblastic leukemia. Thirty-six evaluable patients who achieved two or more remissions were given adriamycin, 10 mg/m2/week, as a single maintenance agent. The median duration of second remission was 17 weeks, but only 5 weeks for third and fourth remission. Although the therapy was not found effective in more advanced disease, the median duration of second remission approached that obtained from various multi-agent treatment schedules. We conclude that the therapeutic efficacy of this treatment schedule makes it appealing for incorporation into multi-drug combination regimens.

Assessment of adriamycin cardiotoxicity in children by systolic time intervals

In a prospective study, 44 children receiving Adriamycin (ADR) for various neoplastic diseases underwent serial estimations of the systolic time intervals (STI) for the noninvasive assessment of left ventricular myocardial performance. Five of the 44 children developed clinical signs of ADR-related congestive heart failure at a cumulative dose of less than 550 mg/m2 body surface area. Clinical symptoms, changes in the electrocardiogram and in the chest X-ray were preceded in every case by changes of the STI, mainly a prolongation of the left ventricular pre-ejection period (PEP), or a decrease of the ejection time (ET)/pre-ejection period (PEP) ratio (ET/PEP). A continous increase of the PEP and a decrease of the ET/PEP-ratio also gave an indication of myocardial dysfunction during ADR treatment in the other children without clinical signs of congestive heart failure. This subclinical cardiotoxic effect of ADR below the critical cumulative dose of 550 mg/m2 was observed in children with pre-existent myocardial damage, with preceding thoracic irradiation, or during concurrent chemotherapy, of which cyclophosphamide seemed to be most important. Thus, the estimation of the STI proved helpful and reliable in the early detection of incipient heart failure and in the selection of high risk patients in children receiving ADR treatment.